What is the role of anterior surgery in the treatment of kyphosis?

Updated: May 04, 2020
  • Author: R Carter Cassidy, MD; Chief Editor: Jeffrey A Goldstein, MD  more...
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Answer

Anterior surgery can include single or multiple diskectomies to increase the flexibility of the spine, followed by a posterior arthrodesis. The transthoracic approach allows decompression of the neural elements before the spine is corrected with posterior instrumentation. Anterior-only fusion is most useful for treating relatively short and focal kyphosis, such as posttraumatic or postinfectious kyphosis. [23]

A consecutive series of 48 patients were treated for severe deformity with either anterior diskectomy and posterior fusion or vertebral-column resection and followed for at least 2 years. In this case series, the vertebral-column resection group had better correction but also more blood loss, longer operating times, and longer hospital stays. Patient-reported outcome scores were similar in the two groups. [56]

A novel technique for single-curve scoliosis may also be used to correct kyphosis. The bone-on-bone technique involves an anterior-only approach to perform complete annulectomy and diskectomy at each level in the Cobb angle of the deformity. Then, using sequential compression along two rods, which are affixed with a staple and two screws in each vertebral level, the surgeon brings the bony endplates into immediate contact. Substantial correction can be achieved in this manner. [57]

A technique called anterior-column restoration relies on multiple lateral interbody fusions to release the anterior longitudinal ligament and realign the spine. This is often followed by an open posterior fusion. Possible benefits of this technique over posterior-only bony resection may include less blood loss and dural manipulation and excellent sagittal plane correction; however, further study is needed. [58]


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